Double ‘pink tooth’ associated with extensive internal root resorption after orthodontic treatment: a case report

Abstract

Advanced internal resorption affecting the crown of teeth may result in the appearance of a 'pink tooth', which, when located in the root canal, can perforate the external root surface. Therapeutically, this condition represents a clinical challenge and normally requires a combined endodontic and surgical focus. Presented herein are cases of double 'pink tooth' which appeared at different times after orthodontic treatment. In the most severe case, upon radiographic examination and computed tomography, the maxillary right central incisor presented an internal resorption, extending from the pulp chamber to the root middle third. After pulp removal, the debridement of the defect was performed using a 2.5% sodium hypochlorite solution, a #80 Kerr file, and an ultrasonic tip ST-17, aided by a surgical microscope. During the cleaning process, various sites of periodontal communication were identified. Upon controlling the hemorrhaging, the root canal was completely filled with White mineral trioxide aggregate. Within the 3-month follow-up treatment, a pink spot appeared on the maxillary left central incisor, which received conventional root canal therapy. Clinically and radiographically, over 18 months of follow up, both cases responded favorably to the proposed treatments. Therefore, it is important to monitor the patient due to the fact that pulp and periodontal sequelae can develop at varied moments after orthodontic treatment. Furthermore, with the current technology and biomaterials, it is possible to resolve cases with extensive internal perforating resorption through endodontic treatment.

Internal resorption: an unusual form of tooth resorption

“…Although most cases are progressive, some cases are transient and arise in traumatised teeth or those that have recently undergone orthodontic or periodontal therapy. 7 For IR to occur, the outermost protective odontoblast layer and the predentin of the canal wall must be damaged, resulting in…”

“…Various aetiological factors have been proposed for the loss of predentin, including trauma, caries and periodontal infections, excessive heat generated during restorative procedures on vital teeth, calcium hydroxide idiopathic dystrophic changes within normal pulp. 3,[7][8][9][10][11][12][13] In a study of 25 teeth with IR, trauma was found to be the most common predisposing factor that was responsible for 45% of cases examined. 14 The suggested aetiologies in the other cases were inflammation as a result of carious lesions (25%) and carious/periodontal lesions (14%).…”

Green discoloration of the crown after internal root resorption treatment with grey mineral trioxide aggregate (MTA)

“…The present case demonstrated a successful treatment of a perforating internal root resorption with grey MTA. Successful surgical and nonsurgical treatment of internal resorption in both primary and permanent teeth using MTA has been reported previously in several case reports (5,(9)(10)(11). MTA is biocompatible (12) and has been shown to be effective in repairing furcation perforations (13) and lateral root perforations (14).…”

Management of Internal Resorption: A Catch-22 Situation

“…Various etiological factors have been proposed for the loss of predentin, including trauma, caries and periodontal infections, excessive heat generated during restorative procedures on vital teeth, calcium hydroxide procedures, idiopathic dystrophic changes within normal pulp, etc. [6][7][8][9][10][11][12] In this case report, the patient's chief complaint was pink color of the crown in #21. The pink discoloration (pink tooth of Mummery, named after the anatomist James Howard Mummery) was due to granulation tissue in growth.…”